MSSA Screening Program Cuts Infections in NICUs

An active methicillin-susceptible S. aureus (MSSA) screening and decolonization program in the neonatal intensive care (NICU) unit can lead to a sustained reduction in the incidence of clinical S. aureus isolates, according to a study published in Infection Control & Hospital Epidemiology.

Staphylococcus aureus remains a leading cause of hospital-acquired infections in neonates. While some NICUs use active surveillance cultures (ASCs) and decolonization to prevent methicillin-resistant S. aureus (MRSA) transmission and infections, methicillin-susceptible S. aureus (MSSA) infections occur even more frequently in neonate populations and have similar mortality.

Prior to April 2013, the Johns Hopkins NICU screened neonates for MRSA colonization and carriers were decolonized. However, the program was subsequently expanded to include MSSA screening and decolonization. Researchers previously showed that implementation of MSSA ASCs and targeted decolonization resulted in decreases in S. aureus clinical cultures and infections decreased, but examined more recent data (April 1, 2011, through June 30, 2016) to assess whether the reduction was sustained over 3 years.

The researchers found that over the 24 months before implementation of the screening and decolonization intervention (29,200 patient days) there were 74 NICU-attributable S. aureus clinical cultures versus 68 in the 39 months post-implementation (47,135 patient days).  Overall, there was a 43 percent reduction in the incidence rate of S. aureus clinical isolates comparing the post- to the pre-intervention period. During the post-intervention period, 1,847 neonates were screened for S. aureus colonization, 333 colonized patients were identified and 243 were treated with mupirocin.

“Incorporating MSSA screening into a NICU’s infection control protocol may be an important step to reduce S. aureus infections in this vulnerable neonatal population,” write the authors led by Annie Voskertchian, from Johns Hopkins University in Baltimore, Md.

Takeaway: An active MSSA screening and decolonization program can lead to sustained reductions in the incidence of clinical S. aureus infections in NICUs.